One of the newest branches of biology is the field of proteomics, the
study of the proteins produced inside cells. New understanding about
cell proteins is being used to create new tests for disease, and one
new test being developed could help doctors diagnose appendicitis.
Appendicitis is one of the world's most common medical problems. Over the course of a lifetime, people have about a one in 10 chance of needing surgery to remove an inflamed or even a ruptured appendix. But Hanno Steen, director of The Proteomics Center at Children's Hospital Boston, says many people who arrive at a doctor's office don't get the correct diagnosis - anywhere between 5 and 30 percent of patients.
"That means that for every 20 surgeries or appendectomies being done, at least one of them is wrong… meaning they cut somebody open, then figure out the appendices were alright," Steen says. "Even worse… when they miss the diagnosis, and that also happens actually quite commonly."
Steen and his colleague Alex Kentsis wondered if there might be a protein that the body produces only when the appendix is inflamed. They collected urine from dozens of children with abdominal pain - some of the children ended up having appendicitis, some did not. Steen and Kentsis used sophisticated molecular screening techniques to see if there were any proteins present only in the urine from children with appendicitis. And they found one.
"If one has the biomarker in urine, then you can envision some dipstick test where either you pee in a cup and you hold this dipstick in there and then you see color change," Steen says.
"Or you have a little stick like the test like the pregnancy test, where you pee directly on a stick and then you see a color change. You see a plus or minus popping up and then based on that you can already say with good probability whether this patient has appendicitis or not."
Steen says the advantages to such a test would be enormous… first of all, it would save time. That means many people who do have infected appendices would be at less risk of delayed surgical care.
What Steen really likes is that this method would be far cheaper and more accessible than the X-rays and other tests used in Western countries to confirm a diagnosis of appendicitis.
"We also have to think about what happens in other regions of this country or in other regions of the world, where they don't have imaging technology like CT and ultrasound at hand," he says.
Steen says his next step is to repeat the trial to ensure that, indeed, this biomarker does indicate appendicitis. But he and Kentsis are confident it does, and they think it should take only a few years before this technology is confirmed and is in the hands of doctors worldwide.
Steen and Kentsis' research is published in the Annals of Emergency Medicine.